Browsing by Subject "Antidepressants"

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    Investigating the Effects of Antidepressants on Intestinal Bacteria
    (2024-04-16) Lebakken, Sophia; Basting, Christopher M; Bailey, Melisa; Schroeder, Ty; Broedlow, Courtney A; Guerrero, Candace; Hemmila, Charlotte; Klatt, Nichole R
    Introduction: The gut-brain axis (GBA) involves bidirectional communication between the gastrointestinal tract and brain, which contains many species of bacteria that play an important role in this communication. Major depressive disorder is often treated with antidepressant medications (ADMs) that pass through the gastrointestinal tract; however, the possible adverse effects of ADMs on the gut microbiome are not well characterized. Methods: This project investigates the impact of three selective serotonin reuptake inhibitors, sertraline, fluoxetine, citalopram; one norepinephrine and dopamine reuptake inhibitor, bupropion; and one tetracyclic antidepressant, mirtazapine, on the growth of eight species of gut bacteria, Bacteroides fragilis, Bifidobacterium longum, Bacteroides uniformis, Collinsella aerofaciens, Prevotella copri, Escherichia coli, Akkermansia muciniphila, and Lactobacillus plantarum. Bacteria were treated with various concentrations of each ADM to determine potential impact on growth. We calculated the concentration of drug needed to inhibit growth by 50% (IC50) using spectrophotometry. Results Several ADMs inhibited gut bacterial growth. At 50% bacterial growth inhibition, the most prominent was sertraline (28.742 μM), followed by bupropion (43.976 μM), then fluoxetine (76.449 μM). Citalopram (244.738 μM) and mirtazapine (294.316 μM) exhibited far less inhibition. Discussion These findings suggest ADMs have antibiotic effects that disturb the microbiome resulting in potential consequences for microbiota-GBA interactions. Building on these results, future experimentation will measure uptake and metabolism of ADMs by exposing bacteria to each drug longitudinally. Metabolites will be characterized using liquid chromatography-mass spectrometry. Conclusion Given the profound impact of the gut microbiome on the gut-brain axis, these data provide novel insights into potential mechanisms by which ADMs could have unintended consequences on the gut that may perpetuate, instead of treat, mood disorders thus the microbiome should be further investigated in relation to ADMs.
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    Medication Utilization of Dual Eligibles Before and After Medicare Part D: Cases of Antidepressants and Antipsychotics
    (2014-05) Kim, Jee-Ae
    Objectives: The study objective is to examine whether medication utilization among dual eligibles was different under Part D compared to Medicaid period by focusing on states which vary baseline state Medicaid policies and wrap-around programs for dual eligibles to access drugs under Part D. The transition of prescription drug benefits to federal Medicare Part D from state Medicaid has potential to affect medication utilization for dual eligibles, beneficiaries for both Medicaid and Medicare programs. Changes in prescription drug benefits under Part D will not equally affect the dual eligible and will differ by states with differences in baseline Medicaid policies and availability of wrap-around programs to access drugs under Part D. The study focuses on antidepressants and antipsychotics. Methods: This study is a pre-post study design with a longitudinal dataset by linking Medicaid data for 2004-2005 and 5% random sample of Medicare data for 2006-2007. The study population is dual eligibles, existing users of antidepressants and of antipsychotics in 2004 and with enrollment from 2004-2007 in eight states. I employ a state-fixed effect model to estimate medication utilization using proportion of days covered (PDC), adjusting for beneficiaries characteristics and health status. I adopt generalized estimation equation (GEE) model for estimating PDC and spline regression for investigating whether changes in PDCs were related to Part D. A stratified analysis is conducted for community based dual eligibles (n=4,703 for antidepressants, n=2,301 for antipsychotics) and nursing home dual eligibles (n=1,504 for antidepressants, n=1,011 for antipsychotics) separately. Results: For antidepressants, adjusted changes in PDC were not significant for most states, except Arkansas community based dual eligibles (p=0.00), Florida nursing home dual eligibles had a significant increase (p=0.03), New Mexico nursing home dual eligibles(p=0.01) under Part D. For antipsychotics, adjusted changes in PDC were not significant in all states except Arkansas community based dual eligibles (p=0.03) and Florida for both groups (p=0.00 for both community based dual eligibles and nursing home dual eligibles). A separate spline regression for states that had significant changes in PDC from the state-fixed effect model indicated that trends in PDC before and after Part D were not significantly different, suggesting that changes were not related to transition to Part D. Conclusions: I did not find empirical support for concerns regarding disruption of medication utilization of the dual eligible under Part D. Although states had different baseline Medicaid polices and wrap-around programs under Part D, lack of significant changes in utilization suggest that minor changes in copayments and refill/prescription limits etc. do not have large effect on medication utilization to antidepressants and antipsychotics.
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    Postpartum Depression: Information and Treatment Options
    (2009-05-04) Keppeler, Philip
    There have been relatively few well-designed studies investigating the efficacy of SSRIs or other antidepressants to treat postpartum depression, and questions remain about the safety of SSRIs for nursing mothers. Although not statistically significant, the study cited in this report and project supports the efficacy and use of antidepressants in a select population of women suffering from postpartum depression. The same study supports cognitive-behavioral therapy (CBT) as equally effective in treating postpartum depression.